@props(['companies'])

<div class="modal" id="modalBeneficiario" tabindex="-1">
    <div class="modal-dialog modal-lg">
        <div class="modal-content">
            <div class="modal-header">
                <h5 class="modal-title">Cadastrar Beneficiario</h5>
                <button type="button" class="btn-close" data-bs-dismiss="modal" aria-label="Close"></button>
            </div>
            <div class="modal-body">
                <input type="hidden" id="product_id_beneficiario">
                <form action="#">
                    <div class="card">
                        <div class="card-header">
                            <h4 class="card-title">Informação Básica</h4>
                        </div>
                        <div class="card-body">
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="name">{{ __('locale.Table.Holders.Column.Name') }}</label>
                                        <input type="text" id="name" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.Name') }}"
                                            name="name" required />
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="cpf">{{ __('locale.Table.Holders.Column.CPF') }}</label>
                                        <input type="text" id="cpf" class="form-control" placeholder="CPF"
                                            name="cpf" data-mask="000.000.000-00" required />
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="rg">{{ __('locale.Table.Holders.Column.RG') }}</label>
                                        <input type="text" id="rg" class="form-control" placeholder="RG"
                                            name="rg" required />
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="issuing_date">{{ __('locale.Table.Holders.Column.IssuingDate') }}</label>
                                        <input type="date" id="issuing_date" class="form-control"
                                            placeholder="{{ __('locale.Table.Holders.Column.IssuingDate') }}" name="issuing_date" required />
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="birth_date">{{ __('locale.Table.Holders.Column.BirthDate') }}</label>
                                        <input type="date" id="birth_date" class="form-control"
                                            placeholder="{{ __('locale.Table.Holders.Column.BirthDate') }}" name="birth_date" required />
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="civil_status">{{ __('locale.Table.Holders.Column.CivilStatus') }}</label>
                                        <select class="form-select" name="civil_status" id="civil_status" required>
                                            <option value="0">{{ __('locale.Table.Holders.Column.CivilStatusSingle') }}</option>
                                            <option value="1">{{ __('locale.Table.Holders.Column.CivilStatusMarried') }}</option>
                                            <option value="2">{{ __('locale.Table.Holders.Column.CivilStatusWidower') }}</option>
                                            <option value="3">{{ __('locale.Table.Holders.Column.CivilStatusDivorced') }}</option>

                                        </select>
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="sus_card">{{ __('locale.Table.Holders.Column.SusCard') }}</label>
                                        <input type="text" id="sus_card" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.SusCard') }}"
                                            name="sus_card"/>
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="issuing_body">{{ __('locale.Table.Holders.Column.IssuingBody') }}</label>
                                        <input type="text" id="issuing_body" class="form-control"
                                            placeholder="{{ __('locale.Table.Holders.Column.IssuingBody') }}" name="issuing_body" required />
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="mother_name">{{ __('locale.Table.Holders.Column.MotherName') }}</label>
                                        <input type="text" id="mother_name" class="form-control"
                                            placeholder="{{ __('locale.Table.Holders.Column.MotherName') }}" name="mother_name" />
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="sex">{{ __('locale.Table.Holders.Column.Sex') }}</label>
                                        <select class="form-select" name="sex" id="sex" required>
                                            <option value="0">{{ __('locale.Table.Holders.Column.SexCisgenderWoman') }}</option>
                                            <option value="1">{{ __('locale.Table.Holders.Column.SexCisgenderMan') }}</option>
                                            <option value="2">{{ __('locale.Table.Holders.Column.SexTransgenderWoman') }}</option>
                                            <option value="3">{{ __('locale.Table.Holders.Column.SexTransgenderMan') }}</option>
                                            <option value="4">{{ __('locale.Table.Holders.Column.SexTranssexualWoman') }}</option>
                                            <option value="5">{{ __('locale.Table.Holders.Column.SexTranssexualMan') }}</option>
                                            <option value="6">{{ __('locale.Table.Holders.Column.SexAgender') }}</option>
                                            <option value="7">{{ __('locale.Table.Holders.Column.SexOthers') }}</option>
                                        </select>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                    <div class="card">
                        <div class="card-header">
                            <h4 class="card-title">Endereço</h4>
                        </div>
                        <div class="card-body">
                            <div class="row">
                                <div class="col-md-12 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="zip_code">{{ __('locale.Table.Holders.Column.AddressZipCode') }}</label>
                                        <input type="text" id="zip_code" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.AddressZipCode') }}" name="zip_code" data-mask="00000-000"required />
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="address">{{ __('locale.Table.Holders.Column.Address') }}</label>
                                        <input type="text" id="address" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.Address') }}"
                                            name="address" required />
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="number">{{ __('locale.Table.Holders.Column.AddressNumber') }}</label>
                                        <input type="text" id="number" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.AddressNumber') }}"
                                            name="number" required />
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="complement">{{ __('locale.Table.Holders.Column.AddressComplement') }}</label>
                                        <input type="text" id="complement" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.AddressComplement') }}"
                                            name="complement"/>
                                    </div>
                                </div>
        
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="district">{{ __('locale.Table.Holders.Column.AddressDistrict') }}</label>
                                        <input type="text" id="district" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.AddressDistrict') }}"
                                            name="district" required />
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="city">{{ __('locale.Table.Holders.Column.AddressCity') }}</label>
                                        <input type="text" id="city" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.AddressCity') }}"
                                            name="city" required />
                                    </div>
                                </div>
        
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="state">{{ __('locale.Table.Holders.Column.AddressState') }}</label>
                                        <input type="text" id="state" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.AddressState') }}"
                                            name="state" required />
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                    <div class="card">
                        <div class="card-header">
                            <h4 class="card-title">Contato</h4>
                        </div>
                        <div class="card-body">
                            <div class="row">
                                <div class="col-md-12 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="email">{{ __('locale.Table.Holders.Column.E-mail') }}</label>
                                        <input type="text" id="email" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.E-mail') }}" name="email" />
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="personal_phone">{{ __('locale.Table.Holders.Column.PersonalPhone') }}</label>
                                        <input type="text" id="personal_phone" class="form-control"
                                            placeholder="{{ __('locale.Table.Holders.Column.PersonalPhone') }}" name="personal_phone"
                                            data-mask="(00) 0 0000-0000" />
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="corporative_phone">{{ __('locale.Table.Holders.Column.CorporativePhone') }}</label>
                                        <input type="text" id="corporative_phone" class="form-control"
                                            placeholder="{{ __('locale.Table.Holders.Column.CorporativePhone') }}" name="corporative_phone"data-mask="(00) 0 0000-0000" />
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                    <div class="card">
                        <div class="card-header">
                            <h4 class="card-title">Financeiro</h4>
                        </div>
                        <div class="card-body">
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="bank_number">{{ __('locale.Table.Holders.Column.BankNumber') }}</label>
                                        <input type="text" id="bank_number" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.BankNumber') }}"
                                            name="bank_number" required />
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="bank">{{ __('locale.Table.Holders.Column.Bank') }}</label>
                                        <input type="text" id="bank" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.Bank') }}"
                                            name="bank" required />
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="bank_agency">{{ __('locale.Table.Holders.Column.BankAgency') }}</label>
                                        <input type="text" id="bank_agency" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.BankAgency') }}"
                                            name="bank_agency" required />
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="bank_account">{{ __('locale.Table.Holders.Column.BankAccount') }}</label>
                                        <input type="text" id="bank_account" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.BankAccount') }}"
                                            name="bank_account" required />
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="wage">{{ __('locale.Table.Holders.Column.Wage') }}</label>
                                        <input type="text" id="wage" class="form-control campo_preco" placeholder="{{ __('locale.Table.Holders.Column.Wage') }}" name="wage" required />
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="consigned_credit">{{ __('locale.Table.Holders.Column.ConsignedCredit') }}</label>
                                        <div class="form-check form-check-inline">
                                            <label class="form-check-label" for="consigned_credit_yes">{{ __('locale.Table.Holders.Column.Yes') }}</label>
                                            <input class="form-check-input" type="radio" name="consigned_credit" id="consigned_credit_yes" value="1">
                                        </div>
                                        <div class="form-check form-check-inline">
                                            <label class="form-check-label" for="consigned_credit_no">{{ __('locale.Table.Holders.Column.No') }}</label>
                                            <input class="form-check-input" type="radio" name="consigned_credit" id="consigned_credit_no" value="0" checked>
                                        </div>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                    <div class="card">
                        <div class="card-header">
                            <h4 class="card-title">Emprego</h4>
                        </div>
                        <div class="card-body">
                            <div class="row">
                                <div class="mb-1 col-md-6">
                                    <label class="form-label" for="company_id">{{ __('locale.Table.Holders.Column.Company') }}</label>
                                    <select name="company_id" id="company_id" class="select2">
                                        @if ($companies)
                                            @foreach ($companies as $company)
                                                <option value="{{ $company->id }}">{{ $company->name }}</option>
                                            @endforeach
                                        @endif
                                    </select>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="cost_center">{{ __('locale.Table.Holders.Column.CostCenter') }}</label>
                                        <input type="text" id="cost_center" class="form-control"
                                            placeholder="{{ __('locale.Table.Holders.Column.CostCenter') }}" name="cost_center" required />
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="role">{{ __('locale.Table.Holders.Column.Role') }}</label>
                                        <input type="text" id="role" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.Role') }}"
                                            name="role" required />
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="admission_date">{{ __('locale.Table.Holders.Column.AdmissionDate') }}</label>
                                        <input type="date" id="admission_date" class="form-control"
                                            placeholder="{{ __('locale.Table.Holders.Column.AdmissionDate') }}" name="admission_date" required />
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="status">{{ __('locale.Table.Holders.Column.Status') }}</label>
                                        <select name="status" id="status" class="select2">
                                            <option value="1">{{ __('locale.Table.Holders.Column.StatusActive') }}</option>
                                            <option value="0">{{ __('locale.Table.Holders.Column.StatusInactive') }}</option>
                                        </select>
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="pre_existing_cid">{{ __('locale.Table.Holders.Column.Cid') }}</label>
                                        <input type="text" id="pre_existing_cid" class="form-control"
                                            placeholder="{{ __('locale.Table.Holders.Column.Cid') }}" name="pre_existing_cid" />
                                    </div>
                                </div>
                            </div>
        
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="registration">{{ __('locale.Table.Holders.Column.Registration') }}</label>
                                        <input type="text" id="registration" class="form-control" placeholder="{{ __('locale.Table.Holders.Column.Registration') }}" name="registration" />
                                    </div>
                                </div>
        
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="beneficy_end_date">{{ __('locale.Table.Holders.Column.BeneficyEndDate') }}</label>
                                        <input type="date" id="beneficy_end_date" class="form-control"
                                            placeholder="{{ __('locale.Table.Holders.Column.BeneficyEndDate') }}" name="beneficy_end_date"/>
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="wedding_date">{{ __('locale.Table.Holders.Column.WeddingDate') }}</label>
                                        <input type="date" id="wedding_date" class="form-control"
                                            placeholder="{{ __('locale.Table.Holders.Column.WeddingDate') }}" name="wedding_date" />
                                    </div>
                                </div>
                                <div class="col-md-6 col-12">
                                    <div class="mb-1">
                                        <label class="form-label" for="injuction">{{ __('locale.Table.Holders.Column.Injuction') }}</label>
                                        <div class="form-check form-check-inline">
                                            <label class="form-check-label" for="injuction_yes">{{ __('locale.Table.Holders.Column.Yes') }}</label>
                                            <input class="form-check-input" type="radio" name="injuction" id="injuction_yes" value="1" >
                                        </div>
                                        <div class="form-check form-check-inline">
                                            <label class="form-check-label" for="injuction_no">{{ __('locale.Table.Holders.Column.No') }}</label>
                                            <input class="form-check-input" type="radio" name="injuction" id="injuction_no" value="0" checked>
                                        </div>
                                    </div>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-12 mt-2">
                                    <button type="button" id="buttonBeneficiario" class="btn btn-primary"
                                        onclick="javascript:salvarInformacoesBeneficiario()"
                                        data-bs-dismiss="modal">Salvar</button>
                                    <button type="button" class="btn btn-secondary"
                                        data-bs-dismiss="modal">Fechar</button>
                                </div>
                            </div>
                        </div>
                    </div>
                </form>
            </div>
        </div>
    </div>
</div>